Blogs by Rosemary, MT-BC

A hospice patient with Parkinson’s and accompanying confusion is rocking back and forth in his bed when I enter his room in a care facility. At his side an aide is trying to keep him from falling out of bed saying, “No, you’ve got to stay in bed”. He explains the patient has just been put back into bed (being a high fall risk he cannot be in his chair while alone in his room) and the aide needs to leave.

Welcome to my world as a Music Therapist.

Thankfully, this is not my first visit with this patient. I had never seen him this physically agitated before, though I had heard he could be combative at times with staff. I knew he loved religious music so I sat next to the side of his bed and the aide gratefully left his post. I began playing the patient’s favorite hymns. I started with “Amazing Grace” and then “In the Garden”. Throughout all this time he continued rocking back and forth in his bed. I decided to match the tempo of the music with his body motions and began playing old Gospel songs, chaining together “I’ll Fly Away”, “Will the Circle Be Unbroken” and “Count Your Blessings”. Suddenly the patient stopped moving and said, “I’ve got to quit”. Something about how he said it made me stop and wonder if he wanted me to quit…. so I did. And then he said, “Unless you want to do that second one again”. WOW!!! He had been processing the music all along.

I had to think back but then asked if he wanted “In the Garden” again and he said, “Yes”. I began the song. His body rocking never returned and this time he sang a bass line along with me. During the song the patient’s daughter walked quietly into the room and heard her father singing. When we both noticed her and they greeted I was ready to end the session but checked it out with him first. “We could do that last song again”, he said. We did but this time all of us sang in three part harmony.

One of the greatest things I like about my job is the variety. Each day/week brings time with different populations, settings, goals and music.

Part of my week is spent giving adaptive lessons with young people and adults with some developmental disabilities. As our website offers, “Adaptive music education focuses on assisting the student in learning proper technique, elements of music, theory, music history, and expanded repertoire. Adaptive lessons focus more on the student’s process of learning than the outcome of performance, however performance may be a key tool for reinforcement.”

One clear distinction between music therapy and adaptive lessons is that the goal does include the musical product. A music therapist adapts the instrument and/or the learning process so that the student is “successful” in making music.

For instance, a lot of my adaptive lessons students want to play the guitar. By using D-tuning, the student is able to play the D chord just by strumming the guitar in the open position. Then by using either of a specially designed bar that straps on the left hand (usually) or by using a plastic tube that slips over the first finger, the person is able to play the other chords. I also adapt the guitar in another way by placing colored dots on the neck at the appropriate frets for the G and A chords. By working with the identification of the colors “yellow”, “red” and “blue”, for example, a person can soon play a myriad of 2 and 3 chord songs. If the student can join in the singing, it is even better.

Other instruments such as drums and keyboards are also used for adaptive lessons.

Periodically all my students have a recital and there is great pride felt by all to see these individuals perform and then bow at the end of their performance. Homemade cookies and other treats brought by the families and group homes make for a wonderful reception to end the evening.

Would you like to hear a story that will warm your heart? Recently this music therapist met a new hospice client, an elderly woman who is dealing with advanced dementia. When her daughter answered the door she directed me to go upstairs where her mother was waiting for me with Maggie (not her name), “Mom’s angel”, the woman said. In the room the elderly patient was sitting up at the side of the bed with the woman I assumed was Maggie. When I introduced myself to the patient she responded, “I’m scared”. Maggie reassured her and said, “Rosemary is here to do some music with us. It’s OK.”

What ensued next was one of the most delightful and heartwarming assessment sessions I have ever experienced. I began with a live rendition of the old hymn, “In the Garden”, a song I was told was a patient favorite. The patient responded by singing in a voice that got stronger as the song progressed. She did not remember many words, but she matched pitch perfectly. The music had brought the woman’s daughter upstairs and she and Maggie clapped with tenderness at the song’s conclusion. The next suggestion was, “Bringing in the Sheaves”. Again the patient vocalized the melody and was able to sing a few more words of this repetitive song. And now the woman tapped her hands on her legs to establish the marching tempo that she wanted. Cell phone cameras came out and this seemingly frail woman became the one in charge. Maggie suggested some spirituals and she and the patient’s daughter joined in the singing. The patient tried to stand up and if she could have, she would have begun dancing. “Oh, Momma”, the daughter said, “you are wonderful”. And to Maggie she said, we were so afraid to move her but we were right to do it. The story then came out that until a few days ago the mother lived on the West coast where Maggie was one of her caretakers. As the end of her life neared the family wished to have her with them in Iowa. Maggie flew with the old woman on the plane and now was staying through a time of transition. Both women talked about how scared they were to do this, but how many good things have come from it, like receiving music therapy services. The daughter said, “I knew my mother was still in there!” “We had FUN”, the patient said as the session ended.

What goodness! What caring!! Obviously, Maggie is making all the difference in the world in helping this woman transition to her new environment. Would that all of us know a “Maggie” in our lives.

Today was not hard to be humble. I think most people who know me would say that needing to be perfect is not a huge issue for me. But today I received a true gift as a music therapist …. And all I had to do was follow the lead of others.

I walked into a care center for a music therapy initial visit with a hospice patient to find the patient actively dying with family and friends sitting vigil at the bedside.

After introducing myself I asked if they would like some music and was told, “You can play ‘Amazing Grace’ and ‘How Great Thou Art’. Those were Grandma’s favorite songs.” The family joined in singing and tears flowed easily as they sung.

A bit of conversation brought out that the family had been there for two days and were just praying that Grandma could “go home”. “Grandpa is getting her room ready”, the adult grandchild said.

When asked what other music the patient liked I was told, “Oldies”. As I watched the family pour out their love towards this elderly woman I chose to play, “Let Me Call You Sweetheart”. At the song’s conclusion one said, “Grandpa sang that song to Grandma all the time”. This family was wonderful. All I had to do was just give little hints and they led me further. “Do you remember any other songs?”

“Just that silly song Grandpa used to play on the record player all the time to tease her ….something about ‘it’s hard to be Humble’”. Together each of us came up with fragments of verse and phrases of melody and bit by bit we pieced together the refrain of that old Mac Davis hit:

“Oh Lord it's hard to be humble

when you're perfect in every way.

I can't wait to look in the mirror

cause I get better looking each day.

To know me is to love me

I must be a hell of a man.

Oh Lord it's hard to be humble

but I'm doing the best that I can.”

As we sang we all looked at the patient who now began opening and closing her mouth as if trying to sing along. “Grandma’s probably trying to say, ‘Turn that record off, George’”. In the light of that warm, humorous memory, the patient died…. quietly, peacefully. “Grandpa came and got her”, they said.

Yes, today was easy to be humble…. And grateful to be present as this family sang their loved one home.